Despite extensive research documenting the efficacy of cardiovascular disease (CVD) preventive strategies, these are not uniformly applied across diverse patient populations. The applicant for this Midcareer Investigator Award, Dr. Lori Mosca, has an outstanding record of commitment to patient-oriented research to evaluate gender and ethnic differences in CVD risk, barriers to preventive care, and novel methods to increase patient adherence to national prevention guidelines. She has held an NHLBI National Research Career Award in Preventive Cardiology and an NHLBI Mentored Clinical Scientist Development Grant. The K24 grant will support Dr. Mosca to continue a scientific trajectory directed to mentor the next generation of applied scientists in preventive cardiology and to further refine her research skills related to evaluating interventions to improve lifestyle and outcomes in diverse patients at risk for CVD events. The long-term goal of this project is to increase the number and quality of clinical scientists dedicated to research to improving the quality of CVD preventive care in diverse populations. The specific aims are to 1) Protect Dr. Mosca's time to mentor and conduct patient-oriented research in CVD prevention while advancing her skills in clinical research focused on quality CVD outcomes through formal courses, 2) Establish a structured mentoring program in patient-oriented CVD prevention research targeted to early career investigators, and 3) Support new research to test the impact of an intervention involving Dr, Mosca to increase adherence to national guidelines for CVD prevention among 370 high risk patients. A proposed clinical trial takes advantage of the infrastructure of an ongoing study to identify family members and visitors of patients hospitalized with CVD that may also be at increased risk of CVD events due to shared genes and/or lifestyle. The primary outcome of the trial is the % of high risk patients that achieve an optimal cholesterol level at 1 year compared to those receiving a control intervention. Other ongoing studies funded by the NIH and foundations will provide an enriched research environment to support the K24 goals. Columbia University is uniquely suited to train clinical scientists in issues related to minority and women's cardiovascular health as many of our studies have nearly 50% participation by these populations. The research and careers supported by this project are expected to have a positive impact on attainment of the Healthy People 2010 lifestyle and CVD prevention.